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Rice Rice Baby

Matthew DeLaney, MD and Matthieu DeClerck, MD
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20:26
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While RICE is commonly recommended for a wide variety of musculoskeletal conditions, the quality of evidence behind these recommendations is low.

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James S. -

For migraines. How long will you wait to determine if the Compazine or Reglan is effective before moving on to ketorolac. I've typically just given both to start...

Mike W., MD -

THx for the thoughts James. There are many ways to do this and I typically use both up front also
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Amy V. -

I am a loyal listener to your podcast and have learned a lot from this monthly podcast. I was very disappointed to hear your misleading Feb segment about cannabis. I am currently in a medical cannabis certification program, and have learned a tremendous amount about how cannabis works. You did not choose to have a medical cannabis practitioner talk about cannabis, just a friend who obviously doesn't know enough about the plant. It made me frustrated to hear your repeated talk about how there is not a lot of evidenced based knowledge behind cannabis, without acknowledging that the reason for that is due to the DEA classifying it as a schedule I drug, thus inhibiting a lot of research from being able to take place. I found your segment to be uninformed, misleading, and biased against cannabis. I would please ask that you have a medical cannabis practitioner on to further educate the medical community that you serve. Suggestions for such a provider would be Eloise Theisen, NP, or Dr. Bonni Goldstein. Both of those providers have practiced cannabis medicine for a while and could give a much more accurate picture of it's indications, side effects, and dosing regimens.

Amy Valesh-Peterson, FNP, ENP, soon-to-be-medical cannabis practitioner

Mike W., MD -

From Matt Delaney:
Thanks for the feedback. I agree completely that the DEA classification of cannabis has been a huge barrier to getting studies off the ground. The goal of our segment was not to be pro/con cannabis but more to look at the overall level of evidence we have. As you heard in the segment it is interesting that we see a tremendous growth in the use of medical cannabis yet we have very few high quality studies to support the use of cannabis as a medicine.
I'd be happy to talk to a clinician who regularly prescribes cannabis, but I worry that we would still struggle to give any recommendations without more literature. When it comes to medications or any procedural interventions we have to be able to back up any recommendations with firm data. Personally I suspect there are situations where cannabis is an effective therapeutic but I just don't think the literature to date gives us enough guidance. What you or I do in our personal practices with cannabis may be totally appropriate but when putting out a recommendation on the show the evidentiary threshold is much higher.

Amy V. -

I would like to ask to get a cannabis clinician to talk about how cannabis can be used medicinally. Due to the CSA classification it is not possible to get an adequate look at cannabis just by looking at the research, as it is prohibited by federal law. That is not a benchmark that can be used for cannabis due to this restriction, unfortunately. Patients are using cannabis, as it's been around and used for 12,000 years. It's only been demonized in the last 70 years, which is the time in which we've all been practicing. Good resources to talk about cannabis would be Eloise Theisen NP, or Dr. Bonni Goldstein. I hope you are able to get them on the show to do a segment. Listeners need to have accurate and factual information regarding cannabis, so they can talk to their patients that are using cannabis.

Mike W., MD -

Thx Amy!
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Urgent Care Rap February 2021 Written Summary 474 KB - PDF

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